Monitoring and Incentives Key to Improve Health and Education Outcomes in Jordan

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Amman, June 5, 2017— Jordan can improve the quality of health and education services by using incentives and increasing monitoring to strengthen accountability, according to a new World Bank report entitled “The Last Mile to Quality Service Delivery in Jordan.”

Despite high levels of public investment in health and education, both sectors are confronted with notable challenges in the quality of service delivery, the report argues. Improving the performance of health and education service providers will help to capitalize on resources already invested in the infrastructure of these systems and maximize achievements in service quality.

The report summarizes findings from a nationally representative study at the primary healthcare level and from data previously collected from schools in Jordan. It was presented today at a high-level National Symposium in Amman under the auspices of the Ministry of Planning and International Cooperation, the Ministry of Health, and the Ministry of Education. 

Jordan has achieved enrollment rates close to universal at the primary school level, and approximately 88% at the secondary level. However, Jordanian children are not performing as well as their peers globally in math, language and science. In the health sector, Jordan has also achieved remarkable progress over the past two decades, recording huge strides in population, maternal and child health, and significant improvements in communicable diseases. However, the country is grappling with non-communicable diseases (such as cardiovascular diseases and diabetes), which are responsible for three out of four deaths annually.

From a financial perspective, Jordan’s public spending on health and education is higher than many countries. In fact, it spends nearly as much as countries like Germany, Austria, and Poland on education relative to total government expenditure, and almost double that of the MENA regional average on health relative to GDP. While there are examples of best practices in specific schools and health facilities across the country, on average the quality of public services in Jordan faces some challenges. Only one in five doctors takes “vital signs”, and patient visits last only 10 minutes on average. In the education sector, when a student can’t answer a question, only 24% of public school teachers in grades 2 and 3 encourage the student to try again, explain the question, or correct the student without scolding.

Yet, the contrast between Jordan’s spending on health and education, and its lower than expected health and education outcomes is not a matter of means, but rather the quality of service delivery, including how doctors and teachers provide services.

This study highlights the need to put provider accountability at the heart of the reform agenda of the health and education sectors to improve the quality of service delivery in Jordan”, said Imad Fakhoury, Minister of Planning and International Cooperation. “The Government of Jordan is committed to this agenda and has been taking active strides to optimize the use of resources for improved health and education system performance.

The study argues that increasing the monitoring of heads of healthcare centers as well as school principals may yield tangible improvements in the level of effort exerted in the workplace. In conjunction, it is pertinent to introduce strong incentive mechanisms to reap the highest possible gains from monitoring. These measures are at the center of a performance-based accountability system that uses clearly determined indicators to reward service providers. 

This study provides strong empirical evidence about the link between accountability and the quality of health and education service delivery in Jordan. It emphasizes the importance of performance-based systems to address service delivery challenges in quality – a central reform agenda for Jordan moving forward,” said Tamer Rabie, World Bank Lead Health Specialist and Task Team Leader.
 

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